• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.30 no.1
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• pp.34-42
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• 2004

The appropriate care to the dental emergency patients is much important in the aspect of community dental service. To attain such a purpose, the sacred duty of the training of oral and maxillofacial surgeons is required. So, a retrospective study on the characteristics of dental injuries and diseases in emergency care unit will be very meaningful. This study was carried by reviewing the charts and radiographic films of 3,394 patients, treated for dental emergency at Wonju Christian Hospital, Republic of Korea, from January 1, 1993 to December 31, 2002. All patients were classified to 6 groups including trauma, toothache, infection, hemorrhage, TMJ disorder and the others. The clinical characteristics of diseases and treatment modalities according to each group were analyzed. The trauma (73.9%) was the most frequent cause in dental emergency patients, and acute toothache, odontogenic infection, oral hemorrhage, and TMJ disorder were next in order. Gender prediction was male (68%), there were many patients on May and December in the monthly frequency, and the most frequent age group was from 0 to 9 years. In the trauma group, male (68.6%) was predominant, and soft tissue injuries and primary closures were the most frequent type of injury and treatment. In jaw fractures, traffic accidents were the most cause and the weakest site was mandibular symphysis area, and mandibular angle, condyle, and body area were next in order. In the acute toothache group, the cause was dental pulpitis mostly and treatment for that was drug administration mainly. Buccal space abscess in infection group had the largest incidence (24.5%), and common treatments were incision and drainage and medications. In the hemorrhage group, a major cause was postoperative bleeding (60.3%) and hemostasis was obtained by pressure dressing, curettage and suture. For the TMJ disorder group, the peak incidence (63.8%) was shown in the post-traumatic myofascial pain dysfunction syndrome and its primary care was medication such as analgesics and sedatives. In the other group, the various specific symptoms were complained due to acute sialadenitis, trigeminal neuralgia, acute stomatitis, chemical burn, terminal stage neuritis of head and neck cancer, and foreign body aspiration. In conclusion, for the rapid and proper care of the emergency dental diseases, well-trained education should be presented to the intern and resident course of oral and maxillofacial surgery. And it is demanded that oral and maxillofacial surgeons must be prepared in knowledge and skill for such emergency care.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.6
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• pp.439-447
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• 2011

Introduction: In today's society, the rapid and appropriate care of the dental emergency patients is much more important. So, a retrospective study on the characteristics of emergency dental injuries and diseases will be very meaningful. Materials and Methods: This retrospective clinical study was carried by reviewing the radiographic films and emergency chart of 11,493 patients who had visited the emergency room of Hallym Sacred heart Hospital and were treated in the Department of Oral and Maxillofacial Surgery from January 2006 to December 2010. Results: The male to female ratio was 1.9:1. The highest monthly incidence was observed in May (10.4%) and June (8.9%) and the peak age distribution was the first decade (56.0%), followed by the second decade (16.0%). Trauma was the most common cause in dental emergency patients, followed in order by toothache, odontogenic infection, temporomandibular joint (TMJ) disorder and oral hemorrhage. Soft tissue injury was most prevalent in the trauma group, followed by tooth injury and facial bone fractures. In the tooth injury group, tooth fracture (56.7%) showed the highest incidence followed in order by tooth subluxation (18.2%), tooth concussion (16.9%), tooth avulsion (11.5%) and alveolar bone fractures (3.7%). In the facial bone fracture group, mandibular fractures (81.8%) showed the highest incidence followed in order by maxilla fractures (15.7%), nasal bone fractures (9.0%), zygomaticomaxillary complex fractures (5.4%), orbital bone fractures (2.5%). In mandibular bone fractures, the most common location was the symphysis (70.1%), followed in order by the mandibular angle (33.0%), mandibular condyle (22.8%) and mandibular body (13.6%). In the infection group, a submandibular space abscess (46.2%) was most common followed in order by a buccal space abscess (17.4%), canine space abscess (16.9%) and submental space abscess (12.3%). TMJ dislocation (89.3%) showed the highest incidence in the TMJ disorder group, followed by TMJ derangement (10.7%). In the other group, a range of specific symptoms due to post operation complications, trigeminal neuralgia, chemical burns and foreign body aspiration were reported. Conclusion: For the rapid and appropriate care of the dental emergency patients, well-organized system should be presented in oral and maxillofacial surgery. And it is possible under analysis of pattern and the variation of the dental emergency patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.5
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• pp.366-374
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• 2010

Introduction: This study evaluated the capability of silk fibroin (SF) and recombinant human bone morphogenetic protein-2 loaded SF (SF-BMP) as a bone defect replacement matrix when grafted in a calvarial bone defect of rats in vivo. Materials and Methods: A total 70 calvarial critical size defects (5.0 mm in diameter) made on 35 adult female Sprague-Dawley rats were used in this study. The defects were transplanted with (1) rhBMP-2 loaded silk fibroin graft (SF-BMP: 0.8+$10\;{\mu}g$), (2) Silk fibroin (SF: $10\;{\mu}g$), and (3) no graft material (Raw). The samples were evaluated with soft x-rays, alkaline phosphatase activity, calcium/phosphate quantification, histological and histomorphometric analysis at postoperative 4 and 8 weeks. Results: The SF-BMP group ($48.86{\pm}14.92%$) had a significantly higher mean percentage bone area than the SF group ($24.96{\pm}11.01%$) at postoperative 4 weeks.(P<0.05) In addition, the SF-BMP group ($40.01{\pm}12.43%$) had a higher % bone area at postoperative 8 weeks than the SF group ($33.26{\pm}5.15%$). The mean ratio of gray scale levels to the host bone showed that the SF-BMP group ($0.67{\pm}0.08$) had a higher mean ratio level than the SF group ($0.61{\pm}0.09$) at postoperative 8 weeks. These differences were not statistically significant.(P=0.168 and P=0.243, respectively) The ratio of the calcium and phosphate contents of the SF-BMP ($0.93{\pm}0.22$) group was lower than that of the SF ($1.90{\pm}1.42$) group at postoperative 4 weeks. However, the SF-BMP group ($0.75{\pm}0.31$) had a higher Ca/$PO_4$ ratio than the SF ($0.68{\pm}0.04$) at postoperative 8 weeks. These differences were not statistically significant.(P=0.126 and P=0.627, respectively) For the bone-specific alkaline phosphatase (ALP) activity, which is recognized as a reliable indicator of the osteoblast function, the SF-BMP ($23.71{\pm}8.60\;U/L$) groups had a significantly higher value than the SF group ($12.65{\pm}6.47\;U/L$) at postoperative 4 weeks.(P<0.05) At postoperative 8 weeks, the SF-BMP ($21.65{\pm}10.02\;U/L$) group had a lower bone-specific ALP activity than the SF group ($16.72{\pm}7.35\;U/L$). This difference was not statistically significant.(P=0.263) For the histological evaluation, the SF-BMP group revealed less inflammation, lower foreign body reactions and higher bone healing than the SF group at postoperative 4 and 8 weeks. The SF group revealed more foreign body reactions at postoperative 4 weeks. However, this immunogenic reaction decreased and the remnant of grafted material was observed at postoperative 8 weeks. For histomorphometric analysis, the SF-BMP group had a significantly longer bone length to total length ratio than those of the SF group at postoperative 4 and 8 weeks.(P<0.05) Conclusion: The rhBMP-2 loaded silk fibroin graft revealed fewer immunoreactions and inflammation as well as more new bone formation than the pure silk fibroin graft. Therefore, silk fibroin may be a candidate scaffold for tissue engineered bone regeneration.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.2
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• pp.117-122
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• 2003

Background and Objectives : $VoCoM^{\circledR}$ is a commercialized set composed of prefabricated hydroxylapatite implants and shims of various sizes which are specially designed for the type I thyroplasty. Even though a previously published preliminary report showed that $VoCoM^{\circledR}$ is a convenient and safe product for the type I thyroplasty, further investigations or experiences are yet to be reported. Authors aimed to evaluate the efficacy of $VoCoM^{\circledR}$type I thyroplasty, and its advantage and/or disadvantage. Materials and Method : Twenty three consecutive patients with unilateral vocal cord palsy enrolled for the study, who received type I thyroplasty with $VoCoM^{\circledR}$ between July 2001 and June 2003. Acoustic, aerodynamic and stoboscopic analyses were performed prior to surgery and 1 to 3 months after surgery. Speech language pathologists evaluated their voice quality by GRBAS scale, and patients themselves reported subjective changes of their voice by visual analog scale. Results : The average time for the operation was 80 min, which is about 30 min less than other methods. Preoperative jitter was 3.25$\pm$1.65% and improved to 1.94$\pm$1.79% postoperatively (p<0.05). Preoperative shimmer was 9.72$\pm$6.56% and improved to 5.61 $\pm$3.76% (p<0.05), Maximal phonation time increased from 4.41$\pm$2.99 to 7.98$\pm$4.35 sec (p<0.05) The postoperative stroboscopy revealed an effective medialization in 91.3% of the patients. The subjective phonetic improvements were reported in 21 out of 23 patients. GRBAS scale improved from 2.71$\pm$0.46 to 1.47$\pm$1.12(p<0.05). Additional medialization with $Gore-Tex^{\circledR}$ was easily performed in two revision cases. Previously inserted $VoCoM^{\circledR}$ implant was hard to remove because of the tight integration of soft tissues around the implant. Side effects such as extrusion or foreign body reaction are not observed. $VoCoM^{\circledR}$ was relatively expensive and costed more than 10 times of $Gore-Tex^{\circledR}$. Conclusion : Prefabricated hydroxylapatitie implant($VoCoM^{\circledR}$) provides a convenient, safe and efficient way of vocal fold medialization. However it is relatively expensive and hard to remove.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.3
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• pp.285-292
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• 2008

Purpose: The present study was performed to evaluate the effect of surface treatment of the cervical area of implant on bone regeneration in fresh extraction socket following implant installation. Materials and methods: The four minipigs, 18 months old and 30 kg weighted, were used. Four premolars of the left side of both the mandible and maxilla were extracted. ${\phi}$3.3 mm and 11.5 mm long US II plus implants (Osstem Implant co., Korea) with resorbable blasting media (RBM) treated surface and US II implants (Osstem Implant co., Korea) with machined surface at the top and RBM surface at lower portion were installed in the socket. Stability of the implant was measured with $Osstell^{TM}$ (Model 6 Resonance Frequency Analyser: Integration Diagnostics Ltd., Sweden). After 2 months of healing, the procedures and measurement of implant stability were repeated in the right side by same method of left side. At four months after first experiment, the animals were sacrificed after measurement of stability of all implants, and biopsies were obtained. Results: Well healed soft tissue and no mobility of the implants were observed in both groups. Histologically satisfactory osseointegration of implants was observed with RBM surface, and no foreign body reaction as well as inflammatory infiltration around implant were found. Furthermore, substantial bone formation and high degree of osseointegration were exhibited at the marginal defects around the cervical area of US II plus implants. However, healing of US II implants was characterized by the incomplete bone substitution and the presence of the connective tissue zone between the implant and newly formed bone. The distance between the implant platform (P) and the most coronal level of bone-to-implant contact (B) after 2 months of healing was $2.66{\pm}0.11$ mm at US II implants group and $1.80{\pm}0.13$mm at US II plus implant group. The P-B distance after 4 months of healing was $2.29{\pm}0.13$mm at US II implants group and $1.25{\pm}0.10$mm at US II plus implants group. The difference between both groups regarding the length of P-B distance was statistically significant(p<0.05). Concerning the resonance frequency analysis (RFA) value, the stability of US II plus implants group showed relatively higher RFA value than US II implants group. Conclusion: The current results suggest that implants with rough surface at the cervical area have an advantage in process of bone regeneration on defect around implant placed in a fresh extraction socket.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.19 no.3
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• pp.265-286
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• 1997

Bone morphogenetic proteins(BMPs) are a group of transforming growth factor beta(TGF-${\beta}$)-related factors and multifunctional proteins, especially the only known biologic factors capable of inducing endochondral bone formation at an extraskeletal site. This study was performed to investigate the effect of the partially purified porcine BMP(pBMP) at an ectopic site. PBMP was partially purified from porcine bone matrix and its activity was monitored by an in vivo bioassay. The purification method utilized extraction of the bone-inducing activity with 4M guanidine, followed by chromatography on heparin-Sepharose. Active fractions were assayed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. And the fractions were reconstituted with inactive insoluble collagenous bone matrix from rats, acid soluble type I collagen from rat tail and chondroitin-6-sulfate sodium salt and implanted into the pectroralis muscle pouches of Sprague-Dawley rats. And the carrier complex was implanted on the opposite side as control. The rats were sacrificed at the day of 1st, 3rd, 5th, 7th, 11th, 14th and 21st after implantation and examined histologically, radiologically and biochemically. And alkaline phosphatase activity and calcium content were used as indices of bone formation. The results were as follows ; 1. Active fractions were localized in a zone between 31 and 40 KDa on SDS-PAGE. 2. The implanted 3.0mg of the partially purified pBMP induced cartilage and bone in the muscle tissue of rats through an endochondral ossification process. 3. Inactive insoluble bone matrix, type I collagen and chondroitin-6-sulfate have functioned as carriers for pBMP, but revealed some foreign body reactions. 4. Soft X-ray didn't reveal significant change between the experimental and the control group. 5. The alkaline phosphatase activities in the experimental group of 5th, 7th, 11th, 14th and 21st were increased significantly compared with control (p<0.01) with the peak in the group of 11th day. 6. With time, the calcium content of the experimental group increased. And the calcium contents in the experimental group of 11th, 14th and 21st were increased significantly compared with control (p<0.01).

• Journal of Periodontal and Implant Science
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• v.29 no.3
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• pp.483-509
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• 1999

Biodegradable barrier membrane has been demonstrated to have guided bone regeneration capacity on the animal study. The purpose of this study is to evaluate the effects of cultured calvarial cell inoculated on the biodegradable barrier membrane for the regeneration of the artificial bone defect. In this experiment 35 Sprague-Dawley male rats(mean BW 150gm) were used. 30 rats were divided into 3 groups. In group I, defects were covered periosteum without membrane. In group II, defects were repaired using biodegradable barrier membrane. In group III, the defects were repaired using biodegradable barrier membrane seeded with cultured calvarial cell. Every surgical procedure were performed under the general anesthesia by using with intravenous injection of Pentobarbital sodium(30mg/Kg). After anesthesia, 5 rats were sacrificed by decapitation to obtain the calvaria for bone cell culture. Calvarial cells were cultured with Dulbecco's Modified Essential Medium contained with 10% Fetal Bovine Serum under the conventional conditions. The number of cell inoculated on the membrane were $1{\times}10^6$ Cells/ml. The membrane were inserted on the artificial bone defect after 3 days of culture. A single 3-mm diameter full-thickness artificial calvarial defect was made in each animal by using with bone trephine drill. After the every surgical intervention of animal, all of the animals were sacrificed at 1, 2, 3 weeks after surgery by using of perfusion technique. For obtaining histological section, tissues were fixed in 2.5% Glutaraldehyde (0.1M cacodylate buffer, pH 7.2) and Karnovsky's fixative solution, and decalcified with 0.1M disodium ethylene diaminetetraacetate for 3 weeks. Tissue embeding was performed in paraffin and cut parallel to the surface of calvaria. Section in 7${\mu}m$ thickness of tissue was done and stained with Hematoxylin-Eosin. All the specimens were observed under the light microscopy. The following results were obtained. 1 . During the whole period of experiment, fibrous connective tissue was revealed at 1week after surgery which meant rapid soft tissue recovery. The healing rate of defected area into new bone formation of the test group was observed more rapid tendency than other two groups. 2 . The sequence of healing rate of bone defected area was as follows ； test group, positive control, negative control group. 3 . During the experiment, an osteoclastic cell around preexisted bone was not found. New bone formation was originated from the periphery of the remaing bone wall, and gradually extended into central portion of the bone defect. 4 . The biodegradable barrier membrane was observed favorable biocompatibility during this experimental period without any other noticeable foreign body reaction. And mineralization in the newly formed osteoid tissue revealed relatively more rapid than other group since early stage of the healing process. Conclusively, the cultured bone cell inoculated onto the biodegradable barrier membrane may have an important role of regeneration of artificial bone defects of alveolar bone. This study thus demonstrates a tissue-engineering the approach to the repair of bone defects, which may have clinical applications in clinical fields of the dentistry including periodontics.